HomeMy Public PortalAbout10949 FREER ST_Sewer__ DIEPAIiTJIdOENT OF OOUNTY ENS SEWER- SEWAGE DISPOSAL 1
DMSION OF BUILDING AND SAFETY PERMIT APPLICATION
OOUNTY OF I.O8 ANGELES
WILLIAM J. FOX, COUNTY EHOIINCCN BUILDING
ADDRESS
FOR APPU T FILL IN LDDALIT'
BUILDINGNEAREST G�
ADDRESS GROSS ST.
LOCAL DIS MOT 0. SERIAL NO. PERMIT NO-
NEAREST � A S
CRO88 ST.
Bx0 VE Ram far laa}aatfan AT Iam
OWNER –
MAIL UB ZON OOOUPANOY
ADDRESS
C LNG. � / � B PG
CONTRACTOlf
60.IMP.N0. 3 .71
ADDRESS JOB NO. 16
TELNO TRUNK PERMIT NO.
rSTATE
RESISTflA ION NO. 60UNTY ROAD PERMIT N0.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT 1 '2 PERMIT 110.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
81ZH OF LOT OF BLDGS
S Z20 NOW ON LOT CHARGEE
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DIE9gVjfPl ION OF WORK FEE
HOUSE SEWER OONNEOTING TO REIMBURSEMENT FEE
PUBLI08EWER ! 8-m RECEIPT NO. DATE BY
HOUSrz ER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.80
CONNECT ADDITIONAL BIL08.0 E_X0jFTIONklECORDEO
WORK TO HOUSE SEWER 1.00
ER OR REPAIFk EXISTING NO DA E BY
SEWER OR DISPOSAL SYSTEM 1.90
DISDONNECT AND ABANDON SEWER
AMD OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
TANk,8EEPAOI:PIT OR
PITS AMD ORDRAINFIELD 2.00 STATION Z a DEPTH
OESS"OL—DE LL
SPEOIAL CONDITIONS ONLY 2AS / ANHOLE REFERENCE
OWE
TYPE OF ECT10 LENGTH ROM
OWNERS PERMIT $ 1 00R %
M.L TO PFL
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE DONTRAOTEO WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPEOTOR'SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19— NEW HOUSE SEWER p C
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK SE[P.PIT(S)
ADDRESS AMD OR DRA1NFIELO
1 HEREBY AOKNOWLEDGE THAT 1 HAVE READ THIS AFPLI- OESSPOOL ORYWELL❑
CATION AND STATE THAT THE ABOVE 18 CORRECT AND ASREE
TO COMPLY WITH ALL COUNTY ORDINANOES AND STATE LAWS ALTERR,REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS, SEW ED IdPOilAL SYSTEM
1 HEREBY OERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT O AND
AND/OB LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
EWRR
ER OF TH[ ABOVE D BED RE ENTIAL PROPS BACKPI LL 9EPTIC TAN"[]
iEEP.PTT(S)� CESSPOOLS
81SNATURE
OF PERMITTEpr
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